Last week, I was 100% sure I would be having Otto euthanized at today’s appointment with a veterinarian who provides hospice and home-euthanasia services. I won’t beat around the bush; he’s still with us.

There was one important difference between last week and this: The “heat dome” that has kept California roasting for over a week finally broke, and temperatures dropped all the way down into the 80s, a welcome relief from a week with daily highs over 110°F. As dawn broke this morning, we even got a little spotty rain – bizarre for this area and this time of year, but welcome just the same.

As I said in my last post, Otto has never liked heat, and as an old guy, set in his ways, he was super grumpy about not being able to lay in his damp, shady sandbox outside. He didn’t want to be kept indoors (protected from the heat); he wanted to be outside, but outside was just awful! So he was extra miserable.

The veterinarian who came to my home today was impressed by Otto’s insistence at joining the scrum of dogs to greet her at my home-office door, even as young Boone and middle-aged Woody were knocking into him in their effusive greetings. She also was impressed by his intense interest in the treats I gave her to introduce herself to him. He’s also completely continent, in contrast to many of her other patients. Apparently, a lot of the dogs she sees in this type of practice are much closer to the end before their owners call her in, to the point where they won’t get up to greet someone, aren’t eating much, and are in diapers.

That made me feel a little bad; was I being over-anxious, pulling the trigger too soon? Maybe it’s the fact that I’ve been at the deathbed of loved ones – humans – who were in hospice care as well as those who were unable to receive hospice care for some reason; I just don’t want anyone I love to suffer before death. I’ve seen deathbed suffering; it’s ugly and unnecessary.

The doctor put some of my fears at ease. We discussed Otto’s panting, which I have interpreted as a symptom of pain and anxiety. She agreed that pain and anxiety could be a factor in his almost non-stop panting, but said something I’ve never heard before, that a lot of old dogs have enlarged livers (as I have been told Otto also has) and that as the liver enlarges, it pushes up against the diaphragm, and requires a little more forceful breathing.

She agreed that his front paws and elbows appear to be paining him quite a bit, and she could see how he has altered his posture to compensate, but thought that the amount of difficulty he shows in getting up from laying down is not too bad. As skinny as his thighs feel to me now, she thought his muscle tone was decent, given his age.

She also made me feel a bit better about the panic I was in last week. She said that a lot of old dogs have good days and bad days, and even good weeks and bad weeks, but that she often sees old dogs who look like they are death’s door bounce back when minor issues are addressed – and that the heat of last week was just pushing him past his ability to tolerate his chronic arthritic discomfort.

We reviewed his medications; he’s currently on omeprazole (for acid reflux), Galliprant (a non-steroidal anti-inflammatory), and Tramadol (a synthetic opioid). She suggested I add gabapentin back into the mix. I have had him on gabapentin before, for many months while he was also being given the Galliprant, but I could not say I ever saw any difference in either his discomfort or sleeping patterns when he was on it. But she thought the third medication might complement the Galliprant and Tramadol together, so I’ll give that a try again.

All in all, even though he seemed so much better today than he did last week, I’m so glad I brought this vet in for this examination and consultation. Given Otto’s lifelong aversion to slippery floors and most dogs’ apprehension to going to a vet’s office, it’s understandable that when I take him to see one of his regular vets, he always looks worse than he does as home, wide-eyed, trembling, and shaky. A month ago, I brought him to see his internal medicine doctor, and she seemed more dubious about his ability to go on than even I was last week. This morning, on his home turf, Otto seemed, for the most part, like a creaky, limpy, lumpy version of his usual unfailingly well-mannered and friendly self – if a little more unselfconscious about begging for treats than he ever used to be. Now this veterinarian will have an idea about his current baseline – where he is now, and what “too much” might look like. And I got some reassurance that I’m not doing to wrong thing by trying to keep him around at least a little longer.

A final note: Thank you all for your comments with support and advice. I read and appreciate every single one. I feel truly honored to be able to share my magnificent Otto with you, and I am grateful for your care and feeling for him more than I can possibly say.

Three years ago I wrote a blog post about “how to know when the time is right for euthanasia.” A the time, I had three friends and family members who were facing this decision. One dog, Beau, was euthanized not long after I wrote the post. Lena lasted another year before her owner decided that the dog was too disabled to go on. Chaco, the third dog is still living, the last I heard (I don’t hear from that friend very often anymore). But as I said in the post. I hoped it would be at least several years before I was mulling this topic again.

Well, here we are, almost exactly three years later. Guys, I’m having to think hard about this right now, with my nearly 15-year-old heart dog, Otto.

He had surgery on his liver about four years ago, and we keep an eye on that organ with annual abdominal ultrasounds, to make sure that the benign growth that was removed hasn’t grown back. He’s had a handful of teeth extracted for various reasons, including one broken and several cracked. And he’s been receiving an increasing amount and variety of medications for arthritis pain for a couple of years now.

But until recently, he honestly looked pretty darn good for his age. This last year, though, as the arthritis pain has ramped up, he’s moving less, and has lost a lot of muscle tone, especially in his rear legs. His weight is a few pounds less than his ideal “high school weight” and he’s a little on the ribby side – but I’m trying to keep him on the light side, to reduce the burden on his arthritic joints. His worst arthritis is in his elbows and front paws, and the pain seems to be altering his stance – which is probably causing more pain in his shoulders and back. In the past few weeks, all of a sudden (it seems), he just looks awful when he stands around, swaybacked and panting, and with his ears back and face tense.

We’re having a really hideous heat wave in California right now, so that’s not helping as I try to figure out how much of his panting is due to pain and how much is the heat. He’s always hated being hot. Now it’s even too hot for him to find relief, as he’s always done, by digging a hole in his dampened sandbox, in the shade of an umbrella under an oak tree. For the past few days, it’s been over 100 degrees in the shade! I’ve had to make him come in my office and stay with me and the other dogs where it’s cooler – but he hates this, too. He lays down for a few minutes, then gets up, pacing and panting. He scratches at the door, wanting out. I open the door and he gets only halfway through when the wall of heat makes him stop and remember why he’s not already out there. He turns around, stiffly, and stands for long minutes in the middle of my office, panting and with that awful, painful-looking posture, before laying down again. This just breaks my heart! I don’t want him to be in pain.

Is it the dementia that makes him forget it’s too hot to go outside? Absent-mindedness? Stubbornness? Why can’t he seem to get comfortable in my cool office? There are three beds, of varying heights and softness, and he gets first dibs on any of them. But he just doesn’t want to be in here, he wants the heat to go away and he wants to be in his sandbox. I know the heat is temporary, but his arthritis pain is not.

I don’t want him to suffer.

I use several different assessment tools, developed by various experts on hospice and end-of-life issues for dogs, in an attempt to find some objective data points to help me decide whether “it’s time.”

On one, the result translates to, “Quality of life is a definite concern. Changes will likely become more progressive and more severe in the near future. Veterinary guidance will help you better understand the end stages of your pet’s disease process in order to make a more informed decision of whether to continue hospice care or elect peaceful euthanasia.”

On another, the score indicates, “Everything is okay.”

On a third, the score suggests that Otto has “acceptable life quality to continue with pet hospice.”

I discuss Otto’s condition with close friends who know him. My trainer friend Sarah suggests a consultation with a veterinarian who has a housecall practice and specializes in hospice care for animal companions. Well, why and how the heck did I not think of that on my own? I called and made an appointment for next week. For now, a load has been taken off of my mind. I will trust someone whose practice is mostly animals at the end of their lives to help me with this decision.

And in the meantime, of course, the goal is to give Otto the best possible daily experience I am capable of delivering to him. I’m trying to make up for his unhappiness with the heat and the unaccustomed confinement in my (cool) office by taking him and my other dogs to the lake every evening. There’s a place that has a sandy, gravelly (but not sharp) bottom and with water that gets only very, very gradually deeper. It’s where I like to bring small dogs, novice swimmers, and now, my old guy, too.

As shallow as it is close to shore, the water is refreshing but not cold. We can linger at dusk, when the other lake-visitors are all gone, and not get a chill. Woody asks me to throw his ball, and he bounds through the shallow water, happily fetching. Boone looks for opportunities to steal the ball from Woody and then play “catch me if you can!” Otto wades back and forth, back and forth – not like his nighttime dementia pacing, but like a happy water buffalo. Every so often he wades into the deeper water and swims a bit, and then comes back, tail wagging slowly on the surface of the water, looking extremely content. When he’s like this, the end feels far away from now, and I find a little bit of hope that it truly is.

One of my ex-boyfriends from many, many years ago had a sort of dad-joke he’d tell at least once daily. Any time he saw someone doing something with skill, he’d remark on that skill to any other observer and then, with all seriousness, he’d ask, “Well, you know what it takes to do that?” When the other observer would fall into the trap and ask, “No, what?” he’d answer, “Practice!”

Often, I was the hapless person who fell into his trap. When someone asks the question, “Do you know what it takes to do that?” one naturally expects to hear a trick, a shortcut, or some key detail – not that it takes practice. Duh! Nothing comes without practice!

But though it drove me crazy to hear that it takes practice to do complex math in one’s head, or perform a sleight-of-hand trick for a bartender, or paint a straight and dead-level pin-stripe on one’s car, I found myself picking up the habit of telling my own son, and later, my grandson, the same joke. How did I learn to tie that knot, balance on a slackline, back a trailer with accuracy, or speak Spanish? Practice, every time! Both my son and my grandson are just as aggravated as I used to be when told practice is the key – but I also think they get the point. Great competence or skill at tasks is acquired only through repetition.

Which brings me to training our dogs. I recently taught a few basic dog training classes, filling in at my friend’s training center for another instructor who was ill. The participants in the classes had all paid a pretty penny for their admission to the classes, and were eager to teach basic skills to their dogs. But when I asked the participants how many of them had practiced the exercises they had learned in the previous week’s class over the course of the week, fewer than half of the students held up their hands. Not only had they not practiced their part in working with their dogs, they denied their dogs the opportunity to learn to do behaviors on cue – behaviors that their owners desperately wanted them to do!

Training your dog requires decent observation skills, timing, and some physical coordination (to, at a minimum, provide consistent cues and deliver the dog’s reinforcers – and that’s not counting handling a leash!). If you want snappy sits and downs, reliable recalls, sturdy stays, and coordinated loose-leash work, you have to practice! Try to practice teaching your dog the behaviors you want him to learn in at least once session per day and keep in mind that most dogs will learn faster if you practice in many short sessions per day than in one very long session per day.

Recently, a dog was admitted to a veterinary hospital in northern Michigan with symptoms that looked just like those of canine parvovirus type 2 (also known as CPV, CPV2, or just “parvo”) – vomiting, profuse and bloody diarrhea, and lack of appetite – but the dog tested negative for CPV. Soon, other veterinarians in the area began reporting an uptick in the number of cases of suspected CPV – but some dogs tested positive for parvo and some did not, and most of the young dogs with the parvo-like symptoms died.

These cases were reported to the Michigan Department of Agriculture and Rural Development (MDARD), which also received reports from animal control agencies in northern Michigan regarding dogs with the same symptoms. Today, MDARD is working in partnership with local animal control agencies, the Michigan Association of Animal Control Officers, local veterinarians, the Michigan State University Veterinary Diagnostic Laboratory (MSU VDL), and U.S. Department of Agriculture to share information about these cases, which have affected dogs who are fully vaccinated against CPV and dogs with incomplete immunization alike.

Officials at one shelter, the Otsego County Animal Shelter, have been quoted as saying they have seen deaths in only those dogs who were not “properly vaccinated.” They have urged all dog owners in the state to contact their veterinarians to make sure their dogs are current on their vaccinations.

As officials learn more, MDARD is encouraging animal shelters, boarding and daycare kennels, and veterinary staff to follow their strictest intake and vaccination protocols when bringing in new dogs/puppies and continue to follow required isolation protocols and recommended cleaning/disinfection procedures for surfaces and equipment.

For dog owners, especially those living in or traveling with pets to Michigan, MDARD strongly recommends keeping up with routine vaccinations by ensuring dogs/puppies are vaccinated against parvovirus, rabies, canine distemper, adenovirus, parainfluenza, and leptospirosis. And if dogs or puppies are exhibiting signs of illness, keep them at home and away from other dogs and contact your veterinarian.

Fear of viral mutation

CPV first emerged among dogs in Europe around 1976. By 1978 the virus had spread unchecked, causing a worldwide epidemic of myocarditis (inflammation of the heart) and gastroenteritis (inflammation in the intestines).

CPV is closely related to feline panleukopenia virus (FPV), a virus that has been known since the 1920s to infect cats, mink, and other animals. CPV probably arose as the result of two or three genetic mutations in FPV that allowed it to expand its host range to infect dogs. FPV in cats is highly contagious and has a high mortality rate.

The Baker Institute for Animal Health at Cornell University’s College of Veterinary Medicine first isolated the virus in 1978, and by 1979 had developed the first vaccine for parvo. By 1981, Baker Institute scientists had created an improved attenuated vaccine for the disease. Today, Dr. Colin Parrish of the Baker Institute continues to study the virus and its evolution in order to determine whether existing vaccines provide adequate protection from modern strains of CPV.

The original CPV2 has disappeared in the dog population and has been replaced by new antigenic variants, designated CPV2a and CPV2b, which became widespread during 1979 to 1980 and 1984, respectively.

Until DNA sequencing can identify the virus that has affected and killed dogs in Michigan, and researchers learn what vaccination protocol can best protect dogs, owners are encouraged to check their dogs’ vaccination status.

Until more is known about this illness, extraordinary caution might include avoiding walking dogs (and especially puppies) in public places in Michigan, and keeping your dogs away from other dogs. Most importantly, if you live in or have traveled through Michigan, or your dog has been exposed to dogs who live in or have been taken through Michigan recently, and your dog or puppy shows any signs of being ill with vomiting, diarrhea, lack of appetite, or lethargy, contact your veterinarian right away.